Revision: Jan. 19, 2016, midnight
\t \t\tSB 576-FN-A - AS INTRODUCED
2016 SESSION
\t16-2758
\t01/04
SENATE BILL\t576-FN-A
AN ACT\trelative to the penalty for possession and use of fentanyl-class drugs, insurance coverage for substance use disorders, the acceptance of general funds by the controlled drug prescription health and safety program, the membership of the board of medicine and prescribers of controlled drugs and making an appropriation therefor.
SPONSORS:\tSen. Bradley, Dist 3; Sen. Birdsell, Dist 19; Sen. Boutin, Dist 16; Sen. Carson, Dist 14; Sen. Cataldo, Dist 6; Sen. D'Allesandro, Dist 20; Sen. Feltes, Dist 15; Sen. Forrester, Dist 2; Sen. Fuller Clark, Dist 21; Sen. Hosmer, Dist 7; Sen. Kelly, Dist 10; Sen. Lasky, Dist 13; Sen. Little, Dist 8; Sen. Morse, Dist 22; Sen. Pierce, Dist 5; Sen. Sanborn, Dist 9; Sen. Soucy, Dist 18; Sen. Watters, Dist 4; Sen. Woodburn, Dist 1; Rep. Hinch, Hills. 21; Rep. Shurtleff, Merr. 11; Rep. L. Ober, Hills. 37; Rep. Tholl, Coos 5; Rep. Sherman, Rock. 24; Rep. Goley, Hills. 8; Rep. Rosenwald, Hills. 30; Rep. O'Hearne, Sull. 3; Rep. Packard, Rock. 5; Rep. S. Sweeney, Hills. 23
COMMITTEE:\tJudiciary
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ANALYSIS
\tThis bill:
\tI. Adds possession and use of fentanyl-class drugs for the purposes of the penalty under the controlled drug act.
\tII. Clarifies substance use disorder services for treatment for an addictive substance-related condition under the Medicaid managed care program.
\tIII. Clarifies the funding of the controlled drug prescription health and safety program.
\tIV. Adds 2 physician members to the medical review committee.
\tV. Requires prescribers of controlled drugs to submit prescription requests to the controlled drug prescription health and safety program and to take an online examination.
\tVI. Requires the commissioner of the department of health and human services to consult with the commissioner of the department of safety regarding a 24-hour drug crisis hotline.
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Explanation:\tMatter added to current law appears in bold italics.
\t\tMatter removed from current law appears [in brackets and struckthrough.]
\t\tMatter which is either (a) all new or (b) repealed and reenacted appears in regular type.
\t16-2758
\t01/04
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Sixteen
AN ACT\trelative to the penalty for possession and use of fentanyl-class drugs, insurance coverage for substance use disorders, the acceptance of general funds by the controlled drug prescription health and safety program, the membership of the board of medicine and prescribers of controlled drugs and making an appropriation therefor.
Be it Enacted by the Senate and House of Representatives in General Court convened:
\t1 New Paragraph; Controlled Drug Act; Definition Added. Amend RSA 318-B:1 by inserting after paragraph XI the following new paragraph:
\t\tXI-a. ”Fentanyl class drug” shall mean the following drugs: fentanyl, 3-methylfentanyl, 3-methylthiofentanyl, acetylfentanyl, acetyl-alpha-methylfentanyl, alpha-methylfentanyl, alpha-methylthiofentanyl, beta-hydroxy-3-methylfentanyl, beta-hydroxyfentanyl, para-fluorofentanyl, thiofentanyl, alfentanil, carfentanil, remifentanil, sufentanil, and all optical, positional, and geometric isomers of these substances. Drugs which become controlled after September 1, 2015, pursuant to RSA 318:B-1-a; and are known or scheduled with a common name that includes the term “fentanyl”, or “fentanil” shall also be considered as belonging to this class, along with optical isomers of same. Drugs may be added or removed from this classification by action of the general court.
\t2 Controlled Drug Act; Penalties. Amend RSA 318-B:26, I(a)(3) to read as follows:
\t\t\t\t(3) Heroin or its analog [or], crack cocaine, or a fentanyl class drug in a quantity of 5 grams or more, including any adulterants or dilutants.
\t3 Controlled Drug Act; Penalties. Amend RSA 318-B:26, I(b)(4) to read as follows:
\t\t\t\t(4) Heroin or its analog [or], crack cocaine, or a fentanyl class drug in a quantity of one gram or more, including any adulterants or dilutants;
\t4 Controlled Drug Act; Penalties. Amend RSA 318-B:26, I(c)(4) to read as follows:
\t\t\t\t(4) Heroin or its analog [or], crack cocaine, or a fentanyl class drug in a quantity of less than one gram, including any adulterants or dilutants;
\t5 Controlled Drug Act; Controlled Drug Prescription Health and Safety Program. Amend RSA 318-B:32, II-IV to read as follows:
\t\tII. [All costs incurred by the board for the implementation and operation of the program shall be supported through grants, gifts, or user contributions.] The board may charge a fee to individuals who request their own prescription information. The amount charged for an individual's request for his or her prescription information shall not exceed the actual cost of providing that information.
\t\tIII. [There shall be no state general funds appropriated for the implementation or operation of the program.
\t\tIV.] Prescription information relating to any individual, which information does not meet the level established to suggest possible drug abuse or diversion shall be deleted within 36 months after the initial prescription was dispensed. All other information shall be deleted after 3 years.
\t6 Controlled Drug Prescription Health and Safety Program; Access to Program. Amend RSA 318-B:33, II-a to read as follows:
\t\tII-a. Only registered prescribers [and], dispensers, the office of the chief medical examiner, and federal health prescribers and dispensers working in federal facilities located in New Hampshire and Vermont shall be eligible to access the program.
\t7 New Subparagraph; Providing Controlled Drug Prescription Health and Safety Information; Office of the Chief Medical Examiner. Amend RSA 318-B:35, I(c) by inserting after subparagraph (2) the following new subparagraph:
\t\t\t\t(3) The office of the chief medical examiner for the purpose of investigating the death of an individual.
\t8 New Sections; Certain Registrants Required to Submit Requests to the Program Prior to Prescribing Controlled Substances. Amend RSA 318-B by inserting after section 38 the following new sections:
\t318-B:39 Prescribers Required to Submit Requests to the? Program Prior to Prescribing Controlled Substances. Prescribers required to register with the program under this subdivision shall submit prescription requests for controlled substances to the program, except when:
\t\tI. Controlled medications are to be administered or dispensed to patients hospitalized as inpatients in an acute care facility.
\t\tII. Treating acute pain associated with serious traumatic injury, post-operatively, or with an acute medical condition, with clear objective findings by the practitioner, for no more than 30 days.
\t318-B:40 Examination Required. Prescribers required to register with the program shall pass an online examination, established by the board of medicine, demonstrating basic knowledge regarding the safe prescribing of opioids and other controlled substances. The examination required under this section shall coincide with the prescriber's license application and renewal. The examination shall be accessible on both the board of medicine's and the program's Internet websites. If the registrant fails the examination, the registrant shall complete a board of medicine-approved continuing education course online or in person and then retake the examination.
\t9 New Paragraph; Board of Medicine; Rulemaking Added. Amend RSA 329:9 by inserting after paragraph XIX the following new paragraph:
\t\tXX. Content and procedures for the online examination required under RSA 318-B:40.
\t10 Board of Medicine; Medical Review Committee. Amend RSA 329:17, V-a to read as follows:
\t\tV-a. A medical review subcommittee of [11] 13 members shall be nominated by the board of medicine and appointed by the governor and council. The subcommittee shall consist of one member of the board of medicine and [10] 12 other persons, 3 of whom shall be public members, one of whom shall be a physician assistant, and [6] 8 of whom shall be physicians. One of the physician members shall practice in the area of pain medicine or anesthesiology. Any public member of the subcommittee shall be a person who is not, and never was, a member of the medical profession or the spouse of any such person, and who does not have, and never has had, a material financial interest in either the provision of medical services or an activity directly related to medicine, including the representation of the board or profession for a fee at any time during the 5 years preceding appointment. The terms of the public members shall be staggered so that no 2 public members' terms expire in the same year. The subcommittee members shall be appointed for 3-year terms, and shall serve no more than 2 terms. Upon referral by the board, the subcommittee shall review disciplinary actions reported to the board under paragraphs II-V of this section, except that matters concerning a medical director involved in a current internal or external grievance pursuant to RSA 420-J shall not be reviewed until the grievance process has been completed. Following review of each case, the subcommittee shall make recommendations to the board. Funds shall be appropriated from the general fund for use by the subcommittee to investigate allegations under paragraphs I-V of this section. The board shall employ through the office of professional licensure and certification physician as a medical review subcommittee investigator who shall serve at the pleasure of the board. The salary of the medical review subcommittee investigator shall be established by RSA 94:1-a.
\t11 New Subdivision; Substance Use Disorders. Amend RSA 420-J by inserting after section 14 the following new subdivision:
Substance Use Disorders
\t420-J:15 Definitions. In this subdivision:
\t\tI. “ASAM criteria” means the latest edition of the Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions, developed by the American Society of Addiction Medicine.
\t\tII. “Substance use disorder services” means health care services that are provided to a covered person as treatment for an addictive substance-related condition, not including treatment for any condition related to tobacco use.
\t420-J:16 Determination of Medical Necessity; Attestation.
\t\tI. Whenever substance use disorder services are a covered benefit under a health benefit plan subject to this chapter, the health carrier providing such benefits shall use the ASAM criteria as the minimum standard for determining the medical necessity for such services.
\t\tII. On January 1 of each year, each health carrier that provides coverage for substance use disorder services shall file with the commissioner an annual attestation of compliance with this subdivision, including an attestation by its medical director that the carrier is using the most current edition of the ASAM criteria.
\t420-J:17 Treatment Plan. A health carrier may require submission of a treatment plan, including the frequency and duration of treatment, signed by the primary care provider or other appropriately credentialed treating specialist, that the treatment is medically necessary for treatment of the patient’s substance use disorder and is consistent with the ASAM criteria. A health carrier may require an updated treatment plan for outpatient services no more frequently than every 60 days.
\t420-J:18 Prior Authorization. Whenever substance use disorder services are a covered benefit under a health benefit plan subject to this chapter, no prior authorization shall be required for the first 2 routine outpatient visits of an episode of care by an individual for assessment and care with respect to a substance use disorder, or for the first 48 hours of inpatient treatment for emergency substance use disorder services; provided, that the licensed clinician or licensed facility shall provide the carrier notification of admission within 48 hours of the admission. With respect to the initial 72 hours of treatment following admission, medical necessity shall be determined by the treating licensed clinician using ASAM criteria as the maximum standard necessary for determining medical necessity.
\t12 Consultation Required Regarding 24-Hour Hotline. The commissioner of the department of health and human services, in consultation with the commissioner of the department of safety, shall determine whether a 24-hour drug crisis hotline should be established. If it is determined that a 24-hour hotline should be established, the commissioner of the department of health and human services shall submit a report, on or before April 1, 2016, with recommendations relative to staffing the hotline, which department would administer the hotline, how the hotline would be paid for, and other issues necessary to implement the hotline to the fiscal committee of the general court, the president of the senate, the speaker of the house of representatives, and the governor.
\t13 Appropriation. The sum of $100,000 is hereby appropriated to the pharmacy board for the biennium ending June 30, 2017 for the purposes of technology upgrades for the controlled drug prescription health and safety program, established in RSA 318-B:32. The governor is authorized to draw a warrant for said sum out of any money in the treasury not otherwise appropriated.
\t\tI. Section 8 of this act shall take effect July 1, 2016.
\t\tII. The remainder of this act shall take effect upon its passage.
\t\t\t\t\t\t\t\t\t\t\t16-2758
\t\t\t\t\t\t\t\t\t\t\t12/30/15
SB 576-FN-A- FISCAL NOTE
AN ACT\trelative to the penalty for possession and use of fentanyl-class drugs, insurance coverage for substance use disorders, the acceptance of general funds by the controlled drug prescription health and safety program, the membership of the board of medicine and prescribers of controlled drugs and making an appropriation therefor.
FISCAL IMPACT:
The Office of Professional Licensure and Certification, Judicial Branch, and Department of Insurance state this bill may increase state general fund revenue and expenditures in FY 2017 and each year thereafter. There will be no impact on county or local revenue or expenditures.
This bill appropriates $100,000 of general funds to the Pharmacy Board within the Office of Professional Licensure and Certification in FY 2017 for the purposes of this Act.
The Office of Legislative Budget Assistant is awaiting information from the Departments of Health and Human Services, Corrections, and Administrative Services relative to the fiscal impact of this bill. The Departments were last contacted on 12/28/15 to provide the information.
METHODOLOGY:
The Office of Professional Licensure and Certification states this bill clarifies the funding of the Prescription Drug Monitoring Program (PDMP), includes an appropriation of $100,000 for technological upgrades of the PDMP, requires an on-line examination demonstrating basic knowledge regarding safe prescribing of opioids, and adds two physician members to the Medical Review Subcommittee. The new members of the Medical Review Subcommittee will receive mileage and a $100 per diem payment for attendance at meetings. In addition, the bill removes the requirement for the PDMP to accept only grants, gifts, and user contributions for funding and appropriates $100,000 for the purposes of technology upgrades for the PDMP. The Office states that the vendor that supplies the PDMP software indicates that cost to improve the information technology infrastructure and accommodate mandatory use of the PDMP computer program would be an undetermined sum but at least $50,000 to $100,000; the actual amount of the cost for the technology upgrade is indeterminable at this time. The bill also allows the PDMP to charge a fee to an individual who requests their prescription information that equals the actual cost for their prescription information, resulting in an increase in state restricted revenue to cover the cost of providing this information. Finally, there is currently no on-line examination by the Board of Medicine demonstrating basic knowledge regarding safe prescribing of opioids and other controlled substances, and the cost for developing and administering such an examination is indeterminable.
The Judicial Branch states that sections one through four of the bill define "fentanyl class drug" and add "fentanyl class drug" to the penalty provisions of the Controlled Drug Act in RSA 318-B. The fiscal impact on the Branch is in the form of additional felony drug prosecutions. While the Branch is unable to predict the number of prosecutions that would take place, it notes that the per-case cost is projected to be $449 in FY 2017 and $470 in FY 2018.
The Department of Insurance states this bill specifies that no prior authorization be required for the first two routine outpatient visits. The Department is uncertain what impact, if any, this requirement will have on claim costs and hence insurance premiums. Should the requirement cause insurance premiums to increase, there will be an indeterminable increase in state revenue from the insurance premium tax.
The Department of Justice, Judicial Council, and NH Association of Counties state the bill will have no fiscal impact.